KevinMD's Take, September 2, 2010

The patient centered medical home, a model primary care is basing it's future on, may not be catching on with patients. Pauline Chen writes about the concept in a recent New York Times column.

She notes, "many patients reported feeling disoriented. Some felt displaced as they
saw the old one-to-one doctor-patient interactions replaced with
one-to-three or one-to-four relationships involving not only the doctor
but also a whole host of other providers. As offices switched from
paper-based to electronic medical records, other patients reacted to the
distracted clinicians who seemed more focused on learning the new
computer system than on listening to them."

It's not a good start. Of course, this could be simple growing pains as doctors adapt to a drastically new way of practicing medicine. Better communication would solve that.

But if patients don't embrace the team concept, then the entire model could be in jeopardy.

Well, more often than not, pathologists are hedging their interpretation, calling more specimens "cellular atypia."

In a guest post, general surgeon Jeffrey Parks writes, "there are consequences to this hedging. And nowhere in medicine do we
see this more than in mammography and the pathological analysis of
breast biopsy ... what do you do with that information? Well, you call the patient and you
explain that despite overwhelming evidence to suggest a complete
absence of cancer, the pathologist felt that he could not definitively
rule out the possibility of a small focus of neoplastic change. She was
35 years old. Do you tell her to not worry, that the pathologist is just
covering his ass? You can’t say with 100% certainty that I don’t have
cancer, she asks me?"

That forces the surgeon to confront the possibility of taking the next step. In this case, an open breast biopsy. And that does the patient no favors.